Unveiling Tehran's Antibiotic Self-Medication Crisis
of Tehran participants self-medicated with antibiotics
changed antibiotic dosage without medical advice
stopped antibiotics when symptoms disappeared
Imagine this: You wake up with a sore throat and a runny nose. Instead of visiting a doctor, you open your medicine cabinet and take an antibiotic leftover from a previous prescription. You're not a healthcare professional, but you feel confident this will help. This scenario plays out daily in households across Tehran, part of a silent public health crisis that extends far beyond Iran's borders.
What many don't realize is that this seemingly harmless act contributes to a global health threat that could undo a century of medical progress. The Tehran 1399 study 1 revealed an alarming truth: approximately 86% of participants had self-medicated with antibiotics in the past six months. This isn't just about individual health choices—it's about a practice that's quietly fueling one of our greatest medical challenges: antimicrobial resistance 2 .
Antimicrobial resistance might inflict a 1% annual decrease in global GDP, resulting in losses of between 100 and 200 trillion euros worldwide 2 .
Occurs when people use antibiotics to treat self-diagnosed conditions without consulting a healthcare professional or without a valid prescription 2 . It's like trying to fix a complex electrical problem without understanding wiring diagrams—you might get lucky, but you're more likely to make things worse.
The World Health Organization has labeled AMR as one of the top 10 global public health threats 2 . When bacteria are repeatedly exposed to antibiotics without proper medical guidance, they can evolve to survive these medicines, creating "superbugs" that don't respond to treatment.
"Think of antibiotic resistance as an arms race where the bacteria are constantly adapting to our weapons, and improper antibiotic use hands them the blueprint for our defenses."
In 2020, researchers in Tehran conducted what's known as a cross-sectional descriptive study 1 3 . This type of research provides a "snapshot" of a situation at a particular point in time, much like taking a photograph of a moving train to examine its details. Between January and March 2020, they surveyed 932 people living in Tehran, using carefully designed questionnaires to gather information about their antibiotic use habits 1 .
The study employed both self-completed questionnaires (for literate participants) and interviews (for illiterate individuals) to ensure diverse representation 1 . This methodological consideration was crucial for obtaining accurate data across different segments of Tehran's population. All responses were anonymous, and participants were assured of confidentiality—important ethical safeguards that help ensure honest responses 1 .
Cross-sectional descriptive study
January - March 2020
932 people from Tehran
Questionnaires and interviews
| Characteristic | Number | Percentage |
|---|---|---|
| Total Participants | 932 | 100% |
| Self-employed | 764 | 82% |
| Other (companions/parents) | 168 | 18% |
| Practiced self-medication (past 6 months) | 800 | 86% |
The research uncovered clear preferences for certain antibiotics among those who self-medicate. The winners of this dangerous popularity contest were penicillins and cephalosporins, two classes of antibiotics that should be used judiciously to preserve their effectiveness.
| Antibiotic | Number of Users | Percentage | Drug Class |
|---|---|---|---|
| Amoxicillin | 226 | 28.25% | Penicillin |
| Cephalexin | 204 | 25.5% | Cephalosporin |
| Cefixime | 155 | 19.4% | Cephalosporin |
| Azithromycin | 126 | 15.75% | Macrolide |
| Erythromycin | 40 | 5% | Macrolide |
| Ampicillin | 30 | 3.75% | Penicillin |
When researchers asked participants about their reasons for bypassing healthcare professionals, several key themes emerged:
These reasons reflect practical concerns in daily life, but they come with significant risks. "Previous experience" fails to account that similar symptoms can stem from different causes—what worked for a bacterial infection last year won't necessarily help a viral infection today.
Perhaps most revealing was discovering which health issues prompted people to reach for antibiotics without medical advice.
The problem? Most sore throats, coughs, and runny noses are caused by viruses, not bacteria—and antibiotics don't work against viruses 1 . Using antibiotics for viral infections is like using a fire extinguisher to try to cool down a room—it's the wrong tool for the job and creates unnecessary complications.
The study uncovered troubling patterns in how people use antibiotics once they decide to self-medicate:
changed their antibiotic dosage
stopped taking antibiotics once symptoms disappeared
completed the full treatment course as recommended
These behaviors are particularly concerning because improper dosing and premature discontinuation create ideal conditions for bacteria to develop resistance. Stopping antibiotics early is like leaving a job half-finished—it might look done on the surface, but the remaining problems will come back stronger.
| Stopping Point | Number of Participants | Percentage |
|---|---|---|
| After symptoms disappear | 357 | 44.5% |
| After running out of medication | 258 | 32.5% |
| After completing treatment period | 100 | 12.5% |
| After a few days, regardless of outcome | 85 | 10.5% |
The Tehran study's findings become even more significant when viewed alongside global patterns. A 2025 systematic review and meta-analysis examining 71 studies across 63,251 participants revealed that the global pooled prevalence of antibiotic self-medication is 43.0% 2 . Tehran's 86% rate is dramatically higher than this global average.
The same global analysis found regional variations, with the highest rates in:
Students have been identified as the major users of antibiotic self-medication globally at 62.1% 2 . The most common reasons people worldwide give for self-medicating include knowledge gaps about antibiotics (46.19%), previous successful experiences (39.13%), and perceiving their illness as minor (38.10%) 2 .
The Tehran researchers concluded that educational interventions targeting the general public, pharmacists, and healthcare students are particularly important 1 . Based on their findings and similar research worldwide, effective strategies include:
Educating people about when antibiotics work (and when they don't), proper usage, and the dangers of resistance.
Ensuring doctors and pharmacists communicate clearly about antibiotic use and don't prescribe them unnecessarily.
Strengthening enforcement against over-the-counter antibiotic sales without prescriptions.
Harnessing the influence of those who others listen to—including educated family members and community leaders.
"The challenge is significant, but not insurmountable. As the study authors emphasize, raising awareness about proper antibiotic use is essential in combating the escalating challenge of antibiotic resistance and safeguarding public health 1 ."
The silent threat of antibiotic resistance won't be solved by scientists alone. It requires each of us to reconsider our relationship with medicines we've often taken for granted. The next time you or a loved one feels unwell, remember that the contents of your medicine cabinet have implications far beyond your own recovery.
Responsible antibiotic use today ensures these life-saving medicines will still work tomorrow—for all of us. As the Tehran study reveals, the power to change this trajectory lies not just with healthcare providers and policymakers, but with every individual making informed decisions about their health.